1. Treating lacrimal (aqueous) deficiency
Traditional "first-line" treatment for dry eye, while evolving rather noticeably these days, basically still revolves around the concept of plug-n-drop. No matter what the actual diagnosis (aqueous deficiency vs. meibomian gland dysfunction) this seems to be the default treatment. There are infinite variations according to the preferences of the physician. Some doctors may favor more plugging and less dropping, others may favor dropping and no plugging, some like steroids and some don't, some are big Restasis fans and others aren't. But in some form or another, before any other dry eye treatment you're sure to be given some drops and/or have plugs placed in your tear ducts.
Typically one starts with some of the myriad over-the-counter artificial tears available today. If those not enough, one might go on to punctal plugs or - more likely these days, with the greater emphasis on the "inflammatory component of dry eye" - try a topical steroid and/or Restasis (prescription drops).
Plug-n-drop seems to work pretty well for many patients with mild to moderate dry eye.
If you are visiting this website, it is likely that the versions of plug-n-drop you've employed have not been enough to keep your condition under control or keep eye discomfort at bay. You may need to explore more variations on this theme (and believe it or not all artificial tears are NOT equal, nor are all brands of punctal plugs), or you may need to incorporate additional types of treatments and/or lifestyle modifications.
2. Treating meibomian gland dysfunction
The next level in dry eye treatment is usually all about shifting the focus to the meibomian glands. Are they or are they not producing oil? If not... a course of oral antibiotics such as doxycycline may help. If there is inflammatory meibomian gland dysfunction going on, from conditions such as blepharitis, lid hygiene and heat treatment may be very important treatments. Omega 3 supplementation (flaxseed and/or fish oil) is a common additional treatment.
3. Halting the erosion cycle
- Hypertonic ointment
- Night protection for eyes
- Bandage contact lenses
4. Living with it: Practical lifestyle modifications
- Good hydration: drink plenty of water, reducing caffeine intake
- Environmental control (humidify your life, minimize impact of heat & a/c by turning down, redirecting vents etc)
- Eyewear, e.g. Panoptx (day), Tranquileyes (night)
- Identify and replace (if possible) medications which are causing or exacerbating dry eye
- Employ pain management techniques as necessary
- Modify activities
- For more, see Living with dry eye
5. Experimental drugs; surgery
People with dry eye who have tried all the conventional treatments and modified their lifestyles and still aren't able to keep tolerably comfortable are going to be very motivated to keep searching.
So here's where we get into the fun stuff, like autologous serum eyedrops (main from your own blood), DHEA drops (addressing hormonal factor in dry eye), or volunteering to be a guinea pig in a clinical trial.
In some cases, depending on the cause, there may be reason to explore certain surgical approaches such as tarsorrhaphy (partial surgical closure of the eyelids to limit exposure) or other eyelid interventions.
Some doctors are proponents of amniotic membrane transplantation (specifically in cases of conjunctivochalasis) though we have not seen evidence that dry eye patients are benefitting from this.
For more about any of these treatments, please visit Dry Eye Talk.
6. When you reach the end of the line